Boletim epidemiológico: perfil de pacientes com micoses sistêmicas notificados de 2013 a 2018 em hospital de referência do estado de Goiás / Epidemiological bulletin: profile of patients with systemic mycoses notified from 2013 to 2018 in a reference hospital in the state of Goiás

Micoses Sistêmicas são infecções fúngicas causadas por patógenos primários cujo trato respiratório é utilizado como porta de entrada, mas ocasionalmente se disseminam para todo o organismo. As micoses sistêmicas consideradas endêmicas no Brasil são: paracoccidioidomicose, histoplasmose, coccidioidomicose e criptococose. Por se tratarem de doenças fúngicas emergentes constata-se a necessidade de implantação de uma vigilância epidemiológica eficaz, que tenha impacto positivo na saúde pública no que diz respeito à elaboração de diretrizes e execuções de ações para prevenção, tratamento, e controle dessas micoses. Desta forma, este boletim tem como objetivo descrever o perfil de pacientes com micoses sistemas notificados em hospital de referência de Goiás. Trata-se de um estudo transversal descrito, quantitativo, com dados obtidos do Sistema de Informação de Agravos de Notificação (SINAN-NET) de um Núcleo Hospitalar de Vigilância Epidemiológica do estado de Goiás no período de 2013 a 2018

Systemic mycoses are fungal infections caused by primary pathogens whose respiratory tract is used as a gateway, but occasionally disseminate throughout the body. The systemic mycoses considered endemic in Brazil are: paracoccidioidomycosis, histoplasmosis, coccidioidomycosis and cryptococcosis. As they are emerging fungal diseases, there is a need to implement effective epidemiological surveillance, which has a positive impact on public health with regard to the elaboration of guidelines and execution of actions for the prevention, treatment, and control of these mycoses. Thus, this bulletin aims to describe the profile of patients with systemic mycoses reported in a referral hospital in Goiás. This is a descriptive, quantitative, cross-sectional study with data obtained from the Notifiable Diseases Information System (SINAN-NET) of a Hospital Center for Epidemiological Surveillance in the state of Goiás from 2013 to 2018

Imported endemic mycoses in Spain: Evolution of hospitalized cases, clinical characteristics and correlation with migratory movements, 1997-2014.

Endemic mycoses are systemic fungal infections. Histoplasmosis is endemic in all temperate areas of the world; coccidioidomycosis and paracoccidioidomycosis are only present in the American continent. These pathogens are not present in Spain, but in the last years there has been an increase of reported cases due to migration and temporary movements. We obtained from the Spanish hospitals records clinical and demographic data of all hospitalized cases between 1997 and 2014. There were 286 cases of histoplasmosis, 94 of Coccidioidomycosis and 25 of paracoccidioidomycosis. Overall, histoplasmosis was strongly related to HIV infection, as well as with greater morbidity and mortality. For the other mycoses, we did not find any immunosuppressive condition in most of the cases. Although we were not able to obtain data about clinical presentation of all the cases, the most frequently found was pulmonary involvement. We also found a temporal correlation between the Spanish population born in endemic countries and the number of hospitalized cases along this period. This study reflects the importance of imported diseases in non-endemic countries due to migratory movements.

Vertical Transmission of Histoplasmosis Associated With Anti-Tumor Necrosis Factor Therapy.

Therapeutics blocking the activity of tumor necrosis factor (anti-TNF) are a risk factor for invasive fungal infections; however, infectious risks to infants born to mothers receiving anti-TNF therapy are not well defined. We report a case of vertical transmission of disseminated histoplasmosis in a mother-infant pair exposed to anti-TNF therapy.

[Progressive malaise and joint pain after travel to Costa Rica]. / Abgeschlagenheit und Gelenkschmerzen nach Costa-Rica-Reise.

HISTORY AND ADMISSION FINDINGS: We report on a 57-year-old patient presenting with progressive malaise, joint pain and skin rashes one month after visiting Costa Rica. After exclusion of common tropical diseases empiric antibiotic therapy was initiated, however, the patient's symptoms did not improve. INVESTIGATIONS: CT scan of the chest demonstrated an intrapulmonary nodular lesion. Bronchoscopy revealed no pathological changes. Microbiologic analysis of the bronchoalveolar lavage fluids identified no pathogen. An abdominal ultrasound examination did not reveal pathological findings. Serological tests were positive for Histoplasma capsulatum. TREATMENT AND COURSE: Treatment with itraconazole resulted in a fast initial clinical improvement, but complete resolution of all symptoms only occurred after completion of a 6-months course of itraconazole. Serial CT scans demonstrated a continuous regression of the pulmonary lesion. CONCLUSION: Histoplasmosis has a low incidence among travelers. However, histoplasmosis should be considered in patients with respiratory symptoms and history of travel to endemic countries, specifically when common traveler diseases have been excluded. Diagnosis is confirmed by serology, imaging and ultimately by biopsy for histological, cultural and molecular identification of the pathogen. Antimycotic drug therapy is the recommended treatment of choice for symptomatic cases.

Brote de histoplasmosis en la Escuela de Cadetes de la Base Aérea de Morón, Provincia de Buenos Aires, República Argentina / Histoplasmosis outbreak in Morón, Buenos Aires Province, Argentina

Se describe un brote de histoplasmosis que afectó a 6 cadetes de la Fuerza Aérea Argentina, sin antecedentes patológicos previos. Todos consultaron por problemas respiratorios después de haber limpiado un hangar. En ese recinto se encontraron abundantes deyecciones de animales, presuntamente de palomas y murciélagos. Los pacientes sufrieron fiebre, mialgias, taquipnea y tos no productiva. Las radiografías y tomografías de tórax mostraron imágenes pulmonares micronodulares, engrosamiento de los tabiques interalveolares y adenopatías hiliares. Todos tuvieron una evolución favorable y no requirieron tratamiento antifúngico. Las pruebas de inmunodifusión y contrainmunoelectroforesis con antígenos de Histoplasma capsulatum fueron positivas, al igual que las intradermorreacciones con histoplasmina. Se recogieron 5 muestras de tierra del lugar, las que fueron inoculadas por vía intraperitoneal a 20 hámsteres. De los cultivos de hígado y bazo de dichos animales se consiguió aislar la fase micelial de H. capsulatum. La cepa aislada se comparó con las obtenidas de 12 pacientes argentinos utilizando perfiles genéticos y se observó un clado único con más de 96% de similitud, lo que confirma la homogeneidad de las cepas argentinas. Si bien la histoplasmosis es endémica en la Pampa húmeda, este es el primer brote totalmente documentado al sur del paralelo 34°.

An histoplasmosis outbreak affecting 6 previously healthy Air Force cadets is herein presented. The patients suffered from fever and respiratory symptoms after having cleaned an abandoned hangar soiled with pigeons and bat droppings. They all presented fever, myalgia, tachypnea, and nonproductive cough. Chest X-ray and CT scan studies showed disseminated reticulonodular images affecting both lungs. Hiliar adenomegalies were also observed. All patients achieved a favourable outcome without antifungal treatment. Both serologic tests searching for specificic antibodies (immunodiffusion and counterimmunoelectrophoresis) and histoplasmin skin tests were positive in all cases. Five soil samples mixed with pigeons and bat droppings were collected from the hangar. Suspensions of these samples were inoculated into 20 hamsters by intraperitoneal injection; mycelial phase of H. capsulatum was isolated from liver and spleen cultures. The genetic profile of this strain was compared with 12 isolates obtained from Argentinean patients, and a great degree of homogeneity was observed (> 96% similarity). Although histoplasmosis is endemic in the wet Pampas, this is the first epidemic outbreak reported south of the 34th parallel.

[Histoplasmosis outbreak in Morón, Buenos Aires Province, Argentina]. / Brote de histoplasmosis en la Escuela de Cadetes de la Base Aérea de Morón, Provincia de Buenos Aires, República Argentina.

A histoplasmosis outbreak affecting 6 previously healthy Air Force cadets is herein presented. The patients suffered from fever and respiratory symptoms after having cleaned an abandoned hangar soiled with pigeons and bat droppings. They all presented fever, myalgia, tachypnea, and nonproductive cough. Chest X-ray and CT scan studies showed disseminated reticulonodular images affecting both lungs. Hiliar adenomegalies were also observed. All patients achieved a favourable outcome without antifungal treatment. Both serologic tests searching for specificic antibodies (immunodiffusion and counterimmunoelectrophoresis) and histoplasmin skin tests were positive in all cases. Five soil samples mixed with pigeons and bat droppings were collected from the hangar. Suspensions of these samples were inoculated into 20 hamsters by intraperitoneal injection; mycelial phase of H. capsulatum was isolated from liver and spleen cultures. The genetic profile of this strain was compared with 12 isolates obtained from Argentinean patients, and a great degree of homogeneity was observed (> 96% similarity). Although histoplasmosis is endemic in the wet Pampas, this is the first epidemic outbreak reported south of the 34th parallel.

[Assessment of a quantitative PCR method for clinical diagnosis of imported histoplasmosis]. / Evaluación de una técnica de PCR cuantitativa para el diagnóstico clínico de la histoplasmosis importada.

OBJECTIVE: Evaluation of the usefulness of a quantitative real-time polymerase chain reaction-based (RT-PCR) technique for clinical diagnosis of histoplasmosis. METHODS: Primers and probes were designed on the basis of sequences from the ITS regions of ribosomal DNA of 20 clinical strains of Histoplasma capsulatum. LightCycler procedures (Roche Applied Science) were used with probes marked by fluorescence resonance energy transfer (FRET). Reproducibility, sensitivity, and specificity were analyzed. In addition, an internal control was designed to identify false negative results by PCR inhibition. The RT-PCR assay was tested in 22 clinical samples from 14 patients with proven histoplasmosis. In addition, 30 samples from patients with febrile neutropenia or mycoses other than histoplasmosis, and from healthy volunteers were analyzed as controls. RESULTS: The limit of detection of the assay was 1 fg of genomic DNA per microl of sample. The PCR-based technique was reproducible and highly specific. Positive results were obtained in 11/14 (78.6%) patients and in 17/22 (77.3%) clinical samples. RT-PCR was positive in 100% of respiratory secretions and bone marrow samples, but only 70% of sera (p < 0.01). Mean fungal DNA value was 23.1 fg/microl in serum and 4.85 x 10(3) fg/microl in respiratory and bone marrow samples. RT-PCR results were positive in serum from three HIV patients for which antibody detection by immunodiffusion was negative. Specificity was 100%, since PCR results were negative for all the control samples. CONCLUSION: Thes RT-PCR technique is a sensitive, specific method for early diagnosis of histoplasmosis, particularly when respiratory secretions or bone marrow samples are analyzed. The reliability is lower in serum, but it can be used as an additional, complementary technique to culture and serology in HIV patients.

Primer aislamiento de Histoplasma capsulatum de murciélago urbano Eumops bonariensis / First isolation of Histoplasma capsulatum from the urban bat Eumops bonariensis

Se comunica el primer aislamiento de Histoplasma capsulatum var. capsulatum de un murciélago macho de la especie Eumops bonariensis, capturado en la ciudad de Buenos Aires en 2003. Los aislamientos fueron recuperados de bazo e hígado e identificados fenotípicamente. Se los comparó por PCR, con 17 aislamientos clínicos, 12 de pacientes residentes en la ciudad de Buenos Aires y cinco de otros países de América, usando los iniciadores 1283, (GTG)5, (GACA)4 y M13. Con los cuatro iniciadores, los perfiles de los aislamientos de murciélago resultaron idénticos entre sí y más relacionados a los de pacientes de Buenos Aires que a los de otros países (porcentaje de similitud: 91-100% y 55-87%, respectivamente). La alta relación genética entre los aislamientos obtenidos del murciélago y de los humanos residentes en Buenos Aires sugiere una fuente común de infección. Este es el primer registro de E. bonariensis infectado con H. capsulatum en el mundo, y el primer aislamiento del hongo en la población de quirópteros de la Argentina. Así como estos mamíferos actúan como reservorio y dispersan el hongo en la naturaleza, la infección en murciélagos urbanos podría asociarse al elevado número de casos de histoplasmosis entre pacientes inmunodeprimidos en la ciudad de Buenos Aires.

We report the first isolation of Histoplasma capsulatum var. capsulatum from a male bat Eumops bonariensis captured in Buenos Aires city in 2003. The pathogen was recovered from spleen and liver specimens, and was identified by its phenotypic characteristics. PCR with primers 1283, (GTG)5, (GACA)4 and M13 was used to compare both bat isolates with 17 human isolates, 12 from patients residing in Buenos Aires city, and 5 from other countries of the Americas. The profiles obtained with the four primers showed that both bat isolates were identical to each other and closer to Buenos Aires patients than to the other isolates (similarity percentage: 91-100% and 55-97%, respectively). The high genetic relationship between bat isolates and those from patients living in Buenos Aires suggests a common source of infection. This is the first record of E. bonariensis infected with H. capsulatum in the world, and the first isolation of the fungus in the Argentinean Chiroptera population. In the same way as these wild mammals act as reservoir and spread the fungus in the natural environment, infection in urban bats could well be associated with the increase in histoplasmosis clinical cases among immunosuppressed hosts in Buenos Aires city.

[Canine histoplasmosis in Japan].

Histoplasmosis is a fungal infection caused by Histoplasma capsulatum and is distributed a worldwide. Although the disease has been treated as an imported mycosis, some autochthonous human, 1 equine and 4 canine cases suggested that the disease is endemic. Histoplasmosis is classified depending on the variety of causative agent. Histoplasmosis farciminosi known as pseudofarcy, is manifested only in Perissodactyla where it invades lymph nodes and lymph ducts, and is recognized by isolation from horses. Historically, Japan was one of the endemic areas of pseudofarcy before World War II, and more than 20,000 cases were recorded in horses used by the military. Interestingly, Japanese canine histoplasmosis uniformly showed skin ulcers and granulomatous lesions on the skin without pulmonary or gastrointestinal involvement, both of which were very similar to pseudofarcy. It was diagnosed as histoplasmosis by the detection of internal transcribed spacer legions of rRNA gene of H. capsulatum from paraffin embedded tissue samples. Furthermore, the fungal isolate from the human case with no history of going abroad or immigrating was identified as H. capsulatum var. farciminosum by a gene sequence. These facts indicated that pseudofarcy is not only an infectious disease in horses, but also a zoonotic fungal infection. Japanese autochthonous canine histoplasmosis might be a heteroecism of pseudofarcy because of its likeness to the human case, the similarity of clinical manifestations and the historical background at this stage.

Disseminated histoplasmosis in an AIDS patient diagnosed on bone marrow.

A 29 year old male drug addict, who was HIV positive presented with fever and hepatosplenomegaly. Bone marrow examination revealed Histoplasma capsulatum confirmed by PAS & GMS stains. However patient had a rapid downhill course with multiorgan failure and died before specific treatment could be instituted.

La histoplasmosis pulmonar primaria en México / The primary pulmonary histoplasmosis in Mexico

Introducción: La histoplasmosis pulmonar primaria (HPP) en México debería ser considerada un problema de salud pública, no sólo por su magnitud sino por su trascendencia, dada por la gravedad del cuadro clínico y por la elevada tasa de mortalidad. Con respecto a sus implicaciones económicas, su alta incidencia en trabajadores mineros obstaculiza la reexplotación de muchas minas que aún contienen ricas vetas minerales. características de la HPP en México: La gravedad de la HPP se debe especialmente a la gran carga de hongo inhalada en medios ambientes cerrados como cavernas, túneles y pozos, además de viejas minas y construcciones abandonadas que contienen gran cantidad de guano de murciélagos. Otro factor importante asociado a la HPP, lo constituye la aparente alta virulencia de las cepas de Histoplasma capsulatum aisladas en el país. En este artículo, se citan ejemplos y comparaciones entre la gravedad de los cuadros clínicos de los brotes epidémicos mexicanos y estadounidenses. Adicionalmente, se comenta la recuperación rápida de pacientes tratados con anfotericina B liposomal a diferencia del tratamiento con la anfotericina B tradicional

Toxoplasmose: mudando o entendimento epidemiológico no Rio Grande do Sul / Toxoplasmosis: changing epidemiologic concepts in Rio Grande do Sul

O autor apresenta uma revisão crítica sobre aspectos epidemiológicos da histoplasmose no Rio Grande do Sul. Alerta para o risco da doença disseminada em pacientes imunodeprimidos, especialmente com HIV, como infecção oportunística

El espectro clínico-epidemiológico de la histoplasmosis pulmonar: Avances recientes y perspectivas futuras / The clinical-epidemilogical spectrum of pulmonary histoplasmosis. recent advances and future perspectives

La histoplasmosis es una micosis endémica en todos los continentes excepto en la Antártida, causado por el hongo dimórfico Histoplasma capsulatum, var. capsulatum. La infección pulmonar primaria generalmente es asintomática, o una enfermedad febril, autolimitada. Se han reconocido tres categorías diferentes: pulmonar aguda, pulmonar crónica y diseminada progresiva, con ataque al sistema fagocítrico. Las pruebas serológicas, los cultivos del hongo y la histopatología son útiles para establecer el diagnóstico. Los tejidos deben ser teñidos con plata para visualizar las levaduras. El sistema del hemocultivo de lisiscentrifugación, puede detectar al H. capsulatum de una a dos semanas. Existe un procedimiento para la detección del antígeno, muy útil para el seguimiento de la terapia, incluyendo a los pacientes infectados por el virus de la inmunodeficiencia humana (VIH). La terapia antifúngica no está indicada en la mayoría de los enfermos, aunque algunos tienen una enfermedad prolongada (> 3 semanas). El diagnóstico temprano y un tratamiento oportuno con enfotericina B o itraconazol, puede acelerar la resolución de la enfermedad. El flunconazol es una elección razonable en la terapia supresiva crónica

Histoplasmosis ganglionar: a propósito de 1 caso / Ganglial histoplasmosis: a case study

Se presenta el caso de una paciente con histoplasmosis ganglionar, cuyo diagnóstico se efectuó a partir de antecedentes epidemiológicos, pruebas serológicas y estudio histopatológico de ganglios afectos. Se reseñan los aspectos clínicos, el diagnóstico y el tratamiento aplicado a esta enferma. Se revisa el tema y se comparan los resultados con los de otros autores

Caecal perforation in a renal transplant patient with disseminated histoplasmosis.

A renal transplant patient developed a fatal caecal perforation after Histoplasma capsulatum infection acquired abroad. Disseminated histoplasmosis is an uncommon fungal infection, usually seen in patients with impaired immunity. The diagnosis should be considered in immunosuppressed patients who develop prolonged fever or whose health deteriorates unexpectedly after travelling overseas. The infection is endemic in parts of the United States of America but occurs all over the world. Rapid diagnosis is often possible by histological examination of infected tissues. Treatment if started early may lead to recovery, but if it is not treated it is usually fatal.

Distribuiçäo das Pontes de infecçäo do Histoplasma capsulatum var. capsulatum em Rio da Prata, Município do Rio de Janeiro / Distribution of sources of infection of Histoplasma capsulatum var. capsulatum in Rio da Prata, a municipality of Rio de Janeiro (RJ)

Demonstra-se o índice de contaminaçäo do solo pelo Histoplasma capsulatum var. capsulatum, na localidade de Rio da Prata, área periurbana com características rurais, do Município do Rio de Janeiro. A análise de 111 amostras do solo coletadas em diferentes locais determinou 8 (7,2%) amostras positivas, todas obtidas de galinheiros, em um dos quais também foi observado guano de morcegos. O elevado nível de contaminaçäo do solo nesta regiäo pode ser comparado aos níveis observados em áreas endêmicas de histoplasmose nos EUA

Histoplasmosis epidemica: II. Hallazgos en la Cueva del eden (Cunday, Tolima) / Epidemic hystoplasmosis: II. Findings at the Eden Cave (Cunday, Tolima, Col.)

Se informa el estudio realizado en la Cueva del Eden (Cunday, Tolima) para aislar, de las tierras de la cueva y de murcielagos alli capturados, al Histoplasma Capsulatum, como agente causal de una anterior epidemia de histoplasmosis ocurrida entre visitantes de la cueva. El agente se aislo en 8 de las 27 muestras de tierra y guano de murcielago. Se capturaron 233 ejemplares pertenecientes a 4 generos de murcielagos y en los cultivos practicados en higado, pulmon y bazo de cien de ellos, no fue posible aislar el H. Capsulatum